Intensive care medicine
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Intensive care medicine · Jan 1987
The direct measurement of plasma colloid osmotic pressure is superior to colloid osmotic pressure derived from albumin or total protein.
Plasma colloid osmotic pressure (COP) has been calculated from both serum albumin concentration and plasma total protein concentration. These values have been compared to those measured directly using a membrane-transducer oncometer in a group of normal subjects, in a group of critically-ill patients with a variety of primary diagnoses and in a group of hypovolaemic patients before and after plasma volume replacement with 6% hydroxyethyl starch solution. In the normal samples, COP calculated from albumin (COPalb) underestimated the measured COP (COPm) by mean of 2.0 mmHg (p less than 0.002), with correlation coefficient r = 0.39(n/s). ⋯ We conclude that COPalb is an inadequate estimate of COPm particularly in patients where its use may have important clinical consequences. COPtp provides a reasonable estimate of COPm in normal subjects but in patients samples, where albumin: globulin ratio is low COPtp overestimates substantially in many cases. We advocate the direct measurement of COP in critically-ill patients.
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Intensive care medicine · Jan 1987
Retracted PublicationInfluence of cardiac output on thermal-dye extravascular lung water (EVLW) in cardiac patients.
The influence of varying cardiac output (CO) on thermal-dye extravascular lung water (EVLW) was investigated in a total of 40 cardiac surgery patients before the onset of the operation. EVLW was measured by means of the double indicator dilution technique with indocyanine green as the non-diffusible indicator and a microprocessed lung water computer 15 min and 30 min after change of CO. CO was varied from -45% to +70% of the baseline value by nifedipine infusion (CO increases, n = 20) or halothane application (CO decreases, n = 20), respectively. ⋯ CO estimation was comparable for both methods used. Regression analysis revealed no relationship between CO and EVLW as well as between EVLW and various hemodynamic parameters. We conclude that thermal-dye technique for estimation of EVLW may be accurate in spite of changing cardiac output over a wide range.
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Intensive care medicine · Jan 1987
ReviewFluid resuscitation in diabetic emergencies--a reappraisal.
The first objective in diabetic ketoacidosis is to restore the circulating volume and improve tissue perfusion. In any form of hypovolaemic shock the most efficient way of restoring circulating volume is to be use colloid solutions rather than crystalloids. At least three times the amount of crystalloid must be used to achieve the same effect. ⋯ Although currently difficult to define precisely in their more subtle forms, they all produce adverse pathophysiological effects. The fluid loss in diabetic ketoacidosis is equivalent to "half-normal" saline, a relatively hypotonic solution. As well as causing extensive oedema, resuscitation with isotonic saline can increase serum sodium and osmolarity while not providing free water to replace the intracellular losses.
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Intensive care medicine · Jan 1987
Dobutamine in elderly septic shock patients refractory to dopamine.
The hemodynamic effects of dobutamine (2.5-20 micrograms/kg per min) were studied in six elderly patients with septic shock which was refractory to dopamine (15 micrograms/kg per min). Dobutamine infusion resulted in significant increases in cardiac index (CI), stroke index (SI) and left ventricular stroke work index (LVSWI) and similar declines in heart rate (HR), mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), systemic vascular resistance (SVR) and total pulmonary resistance (TPR). ⋯ MAP was unchanged. These data indicate that dobutamine may be a useful adjunct to dopamine therapy in the management of elderly patients with septic shock.